Van Diest Medical Center

All Charges

Charge

Type

Setting

Price

cefTRIAXone 2 g Inj SDV [VDMC]

Facility

$25.65

Service Code	HCPCS J0696
Hospital Charge Code	10376207
Hospital Revenue Code	259
Min. Negotiated Rate	$12.82
Max. Negotiated Rate	$23.08
Rate for Payer: Aetna of IA Commercial	$23.08
Rate for Payer: Aetna of IA Medical Rental Products	$23.08
Rate for Payer: Aetna of IA Medicare	$14.62
Rate for Payer: Amerigroup Medicaid	$12.95
Rate for Payer: Amerigroup Medicare	$12.95
Rate for Payer: Cash Price	$20.52
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$19.24
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$12.82
Rate for Payer: Iowa Total Care Managed Medicaid	$12.82
Rate for Payer: Medical Associates Commercial	$19.24
Rate for Payer: Medical Associates Managed Medicare	$12.82
Rate for Payer: Midlands Choice Commercial	$17.96
Rate for Payer: Molina Healthcare Managed Medicaid	$13.02
Rate for Payer: Molina Healthcare Managed Medicare	$13.01
Rate for Payer: Oscar Health of IA Commercial	$19.24
Rate for Payer: Partners Health Alliance Commercial	$19.24
Rate for Payer: United Healthcare Commercial	$23.08
Rate for Payer: United Healthcare Managed Medicare	$15.13

cefTRIAXone 500 mg Inj SDV [VDMC]

Facility

$23.86

Service Code	HCPCS J0696
Hospital Charge Code	10376345
Hospital Revenue Code	259
Min. Negotiated Rate	$16.70
Max. Negotiated Rate	$21.47
Rate for Payer: Aetna of IA Commercial	$21.47
Rate for Payer: Aetna of IA Medical Rental Products	$21.47
Rate for Payer: Cash Price	$19.09
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$17.90
Rate for Payer: Medical Associates Commercial	$17.90
Rate for Payer: Midlands Choice Commercial	$16.70
Rate for Payer: United Healthcare Commercial	$21.47

cefTRIAXone 500 mg Inj SDV [VDMC]

Facility

$23.86

Service Code	HCPCS J0696
Hospital Charge Code	10376345
Hospital Revenue Code	259
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$21.47
Rate for Payer: Aetna of IA Commercial	$21.47
Rate for Payer: Aetna of IA Medical Rental Products	$21.47
Rate for Payer: Aetna of IA Medicare	$13.60
Rate for Payer: Amerigroup Medicaid	$12.04
Rate for Payer: Amerigroup Medicare	$12.05
Rate for Payer: Cash Price	$19.09
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$17.90
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$11.93
Rate for Payer: Iowa Total Care Managed Medicaid	$11.93
Rate for Payer: Medical Associates Commercial	$17.90
Rate for Payer: Medical Associates Managed Medicare	$11.93
Rate for Payer: Midlands Choice Commercial	$16.70
Rate for Payer: Molina Healthcare Managed Medicaid	$12.11
Rate for Payer: Molina Healthcare Managed Medicare	$12.10
Rate for Payer: Oscar Health of IA Commercial	$17.90
Rate for Payer: Partners Health Alliance Commercial	$17.90
Rate for Payer: United Healthcare Commercial	$21.47
Rate for Payer: United Healthcare Managed Medicare	$14.08

cefuroxime 250 mg/5 mL 50 ml Pow [VDMC]

Facility

$405.20

Service Code	HCPCS A9270
Hospital Charge Code	14112734
Hospital Revenue Code	259
Min. Negotiated Rate	$283.64
Max. Negotiated Rate	$364.68
Rate for Payer: Aetna of IA Commercial	$364.68
Rate for Payer: Aetna of IA Medical Rental Products	$364.68
Rate for Payer: Cash Price	$324.16
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.90
Rate for Payer: Medical Associates Commercial	$303.90
Rate for Payer: Midlands Choice Commercial	$283.64
Rate for Payer: United Healthcare Commercial	$364.68

cefuroxime 250 mg/5 mL 50 ml Pow [VDMC]

Facility

$405.20

Service Code	HCPCS A9270
Hospital Charge Code	14112734
Hospital Revenue Code	259
Min. Negotiated Rate	$202.52
Max. Negotiated Rate	$364.68
Rate for Payer: Aetna of IA Commercial	$364.68
Rate for Payer: Aetna of IA Medical Rental Products	$364.68
Rate for Payer: Aetna of IA Medicare	$230.96
Rate for Payer: Amerigroup Medicaid	$204.50
Rate for Payer: Amerigroup Medicare	$204.63
Rate for Payer: Cash Price	$324.16
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$303.90
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$202.60
Rate for Payer: Iowa Total Care Managed Medicaid	$202.52
Rate for Payer: Medical Associates Commercial	$303.90
Rate for Payer: Medical Associates Managed Medicare	$202.60
Rate for Payer: Midlands Choice Commercial	$283.64
Rate for Payer: Molina Healthcare Managed Medicaid	$205.64
Rate for Payer: Molina Healthcare Managed Medicare	$205.52
Rate for Payer: Oscar Health of IA Commercial	$303.90
Rate for Payer: Partners Health Alliance Commercial	$303.90
Rate for Payer: United Healthcare Commercial	$364.68
Rate for Payer: United Healthcare Managed Medicare	$239.07

cefuroxime 250 mg Tab [VDMC]

Facility

$1.87

Service Code	HCPCS A9270
Hospital Charge Code	10376483
Hospital Revenue Code	259
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna of IA Commercial	$1.68
Rate for Payer: Aetna of IA Medical Rental Products	$1.68
Rate for Payer: Aetna of IA Medicare	$1.07
Rate for Payer: Amerigroup Medicaid	$0.94
Rate for Payer: Amerigroup Medicare	$0.94
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.40
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.94
Rate for Payer: Iowa Total Care Managed Medicaid	$0.93
Rate for Payer: Medical Associates Commercial	$1.40
Rate for Payer: Medical Associates Managed Medicare	$0.94
Rate for Payer: Midlands Choice Commercial	$1.31
Rate for Payer: Molina Healthcare Managed Medicaid	$0.95
Rate for Payer: Molina Healthcare Managed Medicare	$0.95
Rate for Payer: Oscar Health of IA Commercial	$1.40
Rate for Payer: Partners Health Alliance Commercial	$1.40
Rate for Payer: United Healthcare Commercial	$1.68
Rate for Payer: United Healthcare Managed Medicare	$1.10

cefuroxime 250 mg Tab [VDMC]

Facility

$1.87

Service Code	HCPCS A9270
Hospital Charge Code	10376483
Hospital Revenue Code	259
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.68
Rate for Payer: Aetna of IA Commercial	$1.68
Rate for Payer: Aetna of IA Medical Rental Products	$1.68
Rate for Payer: Cash Price	$1.50
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.40
Rate for Payer: Medical Associates Commercial	$1.40
Rate for Payer: Midlands Choice Commercial	$1.31
Rate for Payer: United Healthcare Commercial	$1.68

cefuroxime 750 mg Inj SDV [VDMC]

Facility

$29.63

Service Code	HCPCS J0697
Hospital Charge Code	10376621
Hospital Revenue Code	259
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$26.67
Rate for Payer: Aetna of IA Commercial	$26.67
Rate for Payer: Aetna of IA Medical Rental Products	$26.67
Rate for Payer: Aetna of IA Medicare	$16.89
Rate for Payer: Amerigroup Medicaid	$14.95
Rate for Payer: Amerigroup Medicare	$14.96
Rate for Payer: Cash Price	$23.70
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.22
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$14.82
Rate for Payer: Iowa Total Care Managed Medicaid	$14.81
Rate for Payer: Medical Associates Commercial	$22.22
Rate for Payer: Medical Associates Managed Medicare	$14.82
Rate for Payer: Midlands Choice Commercial	$20.74
Rate for Payer: Molina Healthcare Managed Medicaid	$15.04
Rate for Payer: Molina Healthcare Managed Medicare	$15.03
Rate for Payer: Oscar Health of IA Commercial	$22.22
Rate for Payer: Partners Health Alliance Commercial	$22.22
Rate for Payer: United Healthcare Commercial	$26.67
Rate for Payer: United Healthcare Managed Medicare	$17.48

cefuroxime 750 mg Inj SDV [VDMC]

Facility

$29.63

Service Code	HCPCS J0697
Hospital Charge Code	10376621
Hospital Revenue Code	259
Min. Negotiated Rate	$20.74
Max. Negotiated Rate	$26.67
Rate for Payer: Aetna of IA Commercial	$26.67
Rate for Payer: Aetna of IA Medical Rental Products	$26.67
Rate for Payer: Cash Price	$23.70
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$22.22
Rate for Payer: Medical Associates Commercial	$22.22
Rate for Payer: Midlands Choice Commercial	$20.74
Rate for Payer: United Healthcare Commercial	$26.67

celecoxib 100 mg Cap [VDMC]

Facility

$1.55

Service Code	HCPCS A9270
Hospital Charge Code	10376690
Hospital Revenue Code	259
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of IA Commercial	$1.40
Rate for Payer: Aetna of IA Medical Rental Products	$1.40
Rate for Payer: Aetna of IA Medicare	$0.88
Rate for Payer: Amerigroup Medicaid	$0.78
Rate for Payer: Amerigroup Medicare	$0.78
Rate for Payer: Cash Price	$1.24
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.16
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.78
Rate for Payer: Iowa Total Care Managed Medicaid	$0.77
Rate for Payer: Medical Associates Commercial	$1.16
Rate for Payer: Medical Associates Managed Medicare	$0.78
Rate for Payer: Midlands Choice Commercial	$1.08
Rate for Payer: Molina Healthcare Managed Medicaid	$0.79
Rate for Payer: Molina Healthcare Managed Medicare	$0.79
Rate for Payer: Oscar Health of IA Commercial	$1.16
Rate for Payer: Partners Health Alliance Commercial	$1.16
Rate for Payer: United Healthcare Commercial	$1.40
Rate for Payer: United Healthcare Managed Medicare	$0.91

celecoxib 100 mg Cap [VDMC]

Facility

$1.55

Service Code	HCPCS A9270
Hospital Charge Code	10376690
Hospital Revenue Code	259
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.40
Rate for Payer: Aetna of IA Commercial	$1.40
Rate for Payer: Aetna of IA Medical Rental Products	$1.40
Rate for Payer: Cash Price	$1.24
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.16
Rate for Payer: Medical Associates Commercial	$1.16
Rate for Payer: Midlands Choice Commercial	$1.08
Rate for Payer: United Healthcare Commercial	$1.40

Cellulitis With MCC

Facility

$13,070.73

Service Code	MS-DRG 602
Hospital Charge Code	400
Min. Negotiated Rate	$12,881.29
Max. Negotiated Rate	$13,070.73
Rate for Payer: Amerigroup Medicaid	$13,007.58
Rate for Payer: Iowa Total Care Managed Medicaid	$12,881.29
Rate for Payer: Molina Healthcare Managed Medicaid	$13,070.73

Cellulitis Without MCC

Facility

$6,762.72

Service Code	MS-DRG 603
Hospital Charge Code	401
Min. Negotiated Rate	$6,664.71
Max. Negotiated Rate	$6,762.72
Rate for Payer: Amerigroup Medicaid	$6,730.05
Rate for Payer: Iowa Total Care Managed Medicaid	$6,664.71
Rate for Payer: Molina Healthcare Managed Medicaid	$6,762.72

CENTRAL LINE DRAW/LAB NO OTHR SVC

Facility

$31.00

Service Code	CPT 36591
Hospital Charge Code	7983016
Hospital Revenue Code	761
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: United Healthcare Commercial	$27.90

CENTRAL LINE DRAW/LAB NO OTHR SVC

Facility

$31.00

Service Code	CPT 36591
Hospital Charge Code	7983016
Hospital Revenue Code	761
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$387.38
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Aetna of IA Medicare	$17.67
Rate for Payer: Amerigroup Medicaid	$15.65
Rate for Payer: Amerigroup Medicare	$15.66
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.50
Rate for Payer: Iowa Total Care Managed Medicaid	$15.49
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Medical Associates Managed Medicare	$15.50
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: Molina Healthcare Managed Medicaid	$15.73
Rate for Payer: Molina Healthcare Managed Medicare	$15.72
Rate for Payer: Oscar Health of IA Commercial	$23.25
Rate for Payer: Partners Health Alliance Commercial	$23.25
Rate for Payer: United Healthcare Commercial	$27.90
Rate for Payer: United Healthcare Managed Medicare	$18.29
Rate for Payer: Wellmark IA HMO	$352.16
Rate for Payer: Wellmark IA PPO	$387.38

CENTRAL LINE DRAW/LAB W/OTHR SVC

Facility

$31.00

Service Code	CPT 99211
Hospital Charge Code	4866808
Hospital Revenue Code	761
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: United Healthcare Commercial	$27.90

CENTRAL LINE DRAW/LAB W/OTHR SVC

Facility

$31.00

Service Code	CPT 99211
Hospital Charge Code	4866808
Hospital Revenue Code	761
Min. Negotiated Rate	$15.49
Max. Negotiated Rate	$27.90
Rate for Payer: Aetna of IA Commercial	$27.90
Rate for Payer: Aetna of IA Medical Rental Products	$27.90
Rate for Payer: Aetna of IA Medicare	$17.67
Rate for Payer: Amerigroup Medicaid	$15.65
Rate for Payer: Amerigroup Medicare	$15.66
Rate for Payer: Cash Price	$24.80
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$23.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$15.50
Rate for Payer: Iowa Total Care Managed Medicaid	$15.49
Rate for Payer: Medical Associates Commercial	$23.25
Rate for Payer: Medical Associates Managed Medicare	$15.50
Rate for Payer: Midlands Choice Commercial	$21.70
Rate for Payer: Molina Healthcare Managed Medicaid	$15.73
Rate for Payer: Molina Healthcare Managed Medicare	$15.72
Rate for Payer: Oscar Health of IA Commercial	$23.25
Rate for Payer: Partners Health Alliance Commercial	$23.25
Rate for Payer: United Healthcare Commercial	$27.90
Rate for Payer: United Healthcare Managed Medicare	$18.29

CENTRAL LINE-PHYSICIAN CHARGE

Professional

Both

$774.00

Service Code	CPT 36556
Hospital Charge Code	7982776
Hospital Revenue Code	981
Min. Negotiated Rate	$75.99
Max. Negotiated Rate	$176.48
Rate for Payer: Aetna of IA Medicare	$75.99
Rate for Payer: Amerigroup Medicaid	$78.57
Rate for Payer: Cash Price	$619.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$91.19
Rate for Payer: Iowa Total Care Managed Medicaid	$77.51
Rate for Payer: Medical Associates Commercial	$136.78
Rate for Payer: Medical Associates Managed Medicare	$75.99
Rate for Payer: Midlands Choice Commercial	$176.48
Rate for Payer: Oscar Health of IA Commercial	$131.46
Rate for Payer: Partners Health Alliance Commercial	$113.98

cephalexin 250 mg/5 mL 100ml Oral Liq [VDMC]

Facility

$54.68

Service Code	HCPCS A9270
Hospital Charge Code	10376828
Hospital Revenue Code	259
Min. Negotiated Rate	$38.28
Max. Negotiated Rate	$49.21
Rate for Payer: Aetna of IA Commercial	$49.21
Rate for Payer: Aetna of IA Medical Rental Products	$49.21
Rate for Payer: Cash Price	$43.74
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.01
Rate for Payer: Medical Associates Commercial	$41.01
Rate for Payer: Midlands Choice Commercial	$38.28
Rate for Payer: United Healthcare Commercial	$49.21

cephalexin 250 mg/5 mL 100ml Oral Liq [VDMC]

Facility

$54.68

Service Code	HCPCS A9270
Hospital Charge Code	10376828
Hospital Revenue Code	259
Min. Negotiated Rate	$27.33
Max. Negotiated Rate	$49.21
Rate for Payer: Aetna of IA Commercial	$49.21
Rate for Payer: Aetna of IA Medical Rental Products	$49.21
Rate for Payer: Aetna of IA Medicare	$31.17
Rate for Payer: Amerigroup Medicaid	$27.60
Rate for Payer: Amerigroup Medicare	$27.61
Rate for Payer: Cash Price	$43.74
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$41.01
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$27.34
Rate for Payer: Iowa Total Care Managed Medicaid	$27.33
Rate for Payer: Medical Associates Commercial	$41.01
Rate for Payer: Medical Associates Managed Medicare	$27.34
Rate for Payer: Midlands Choice Commercial	$38.28
Rate for Payer: Molina Healthcare Managed Medicaid	$27.75
Rate for Payer: Molina Healthcare Managed Medicare	$27.73
Rate for Payer: Oscar Health of IA Commercial	$41.01
Rate for Payer: Partners Health Alliance Commercial	$41.01
Rate for Payer: United Healthcare Commercial	$49.21
Rate for Payer: United Healthcare Managed Medicare	$32.26

cephalexin 250 mg Cap [VDMC]

Facility

$1.26

Service Code	HCPCS A9270
Hospital Charge Code	10376759
Hospital Revenue Code	259
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.13
Rate for Payer: Aetna of IA Commercial	$1.13
Rate for Payer: Aetna of IA Medical Rental Products	$1.13
Rate for Payer: Aetna of IA Medicare	$0.72
Rate for Payer: Amerigroup Medicaid	$0.64
Rate for Payer: Amerigroup Medicare	$0.64
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.95
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.63
Rate for Payer: Iowa Total Care Managed Medicaid	$0.63
Rate for Payer: Medical Associates Commercial	$0.95
Rate for Payer: Medical Associates Managed Medicare	$0.63
Rate for Payer: Midlands Choice Commercial	$0.88
Rate for Payer: Molina Healthcare Managed Medicaid	$0.64
Rate for Payer: Molina Healthcare Managed Medicare	$0.64
Rate for Payer: Oscar Health of IA Commercial	$0.95
Rate for Payer: Partners Health Alliance Commercial	$0.95
Rate for Payer: United Healthcare Commercial	$1.13
Rate for Payer: United Healthcare Managed Medicare	$0.74

cephalexin 250 mg Cap [VDMC]

Facility

$1.26

Service Code	HCPCS A9270
Hospital Charge Code	10376759
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.13
Rate for Payer: Aetna of IA Commercial	$1.13
Rate for Payer: Aetna of IA Medical Rental Products	$1.13
Rate for Payer: Cash Price	$1.01
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$0.95
Rate for Payer: Medical Associates Commercial	$0.95
Rate for Payer: Midlands Choice Commercial	$0.88
Rate for Payer: United Healthcare Commercial	$1.13

cephalexin 500 mg Cap [VDMC]

Facility

$1.89

Service Code	HCPCS A9270
Hospital Charge Code	10376897
Hospital Revenue Code	259
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of IA Commercial	$1.70
Rate for Payer: Aetna of IA Medical Rental Products	$1.70
Rate for Payer: Aetna of IA Medicare	$1.08
Rate for Payer: Amerigroup Medicaid	$0.95
Rate for Payer: Amerigroup Medicare	$0.95
Rate for Payer: Cash Price	$1.51
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.42
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$0.95
Rate for Payer: Iowa Total Care Managed Medicaid	$0.94
Rate for Payer: Medical Associates Commercial	$1.42
Rate for Payer: Medical Associates Managed Medicare	$0.95
Rate for Payer: Midlands Choice Commercial	$1.32
Rate for Payer: Molina Healthcare Managed Medicaid	$0.96
Rate for Payer: Molina Healthcare Managed Medicare	$0.96
Rate for Payer: Oscar Health of IA Commercial	$1.42
Rate for Payer: Partners Health Alliance Commercial	$1.42
Rate for Payer: United Healthcare Commercial	$1.70
Rate for Payer: United Healthcare Managed Medicare	$1.12

cephalexin 500 mg Cap [VDMC]

Facility

$1.89

Service Code	HCPCS A9270
Hospital Charge Code	10376897
Hospital Revenue Code	259
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna of IA Commercial	$1.70
Rate for Payer: Aetna of IA Medical Rental Products	$1.70
Rate for Payer: Cash Price	$1.51
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$1.42
Rate for Payer: Medical Associates Commercial	$1.42
Rate for Payer: Midlands Choice Commercial	$1.32
Rate for Payer: United Healthcare Commercial	$1.70

Ceruloplasmin DMCL

Facility

$139.00

Service Code	CPT 82390
Hospital Charge Code	8037510
Hospital Revenue Code	301
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$125.10
Rate for Payer: Aetna of IA Commercial	$125.10
Rate for Payer: Aetna of IA Medical Rental Products	$125.10
Rate for Payer: Aetna of IA Medicare	$79.23
Rate for Payer: Amerigroup Medicaid	$70.15
Rate for Payer: Amerigroup Medicare	$70.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial	$104.25
Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS	$69.50
Rate for Payer: Iowa Total Care Managed Medicaid	$69.47
Rate for Payer: Medical Associates Commercial	$104.25
Rate for Payer: Medical Associates Managed Medicare	$69.50
Rate for Payer: Midlands Choice Commercial	$97.30
Rate for Payer: Molina Healthcare Managed Medicaid	$70.54
Rate for Payer: Molina Healthcare Managed Medicare	$70.50
Rate for Payer: Oscar Health of IA Commercial	$104.25
Rate for Payer: Partners Health Alliance Commercial	$104.25
Rate for Payer: United Healthcare Commercial	$125.10
Rate for Payer: United Healthcare Managed Medicare	$82.01
Rate for Payer: Wellmark IA HMO	$45.88
Rate for Payer: Wellmark IA PPO	$50.47

Know your out-of-pocket cost for care.

All Charges